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perinatal psych Flashcards

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1
Q

what kinds of psychiatric problems do women have during pregnancy?

A
  1. depression

2. BPAD

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2
Q

psych probs post partum?

A
  1. baby blues
  2. peurpeural psychosis
  3. post natal depression
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3
Q

most common cause of maternal mortality is ______

A

suicide

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4
Q

rate of depression in pregnancy?

A

as for baseline

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5
Q

10% risk of depression in T1 if?

A
  1. past hx
  2. previous abortion
  3. previous IUD
  4. unwanted
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6
Q

psych admission and suicide in pregnancy are ______ common than other times

A

less

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7
Q

risks of untreated depression in mum?

A
  1. risk PND

2. risk to baby from maternal neglect

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8
Q

how to tx depression in pregnancy?

A

as for normal adult

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9
Q

can maternal anxiety affect baby?

A

yes, in terms of foetal heart activity and heart rate

high stress = 2x risk of preterm birth

affects sleep in babies and toddlers

BUT are these associations real biological?

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10
Q

cortisol and psych distress in pregnancy?

A

increased cortisol = lower fetal weight

also increased intrauterine arterial resistance = LBW

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11
Q

negative consequences of maternal depression are related to _________

A

length of illness

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12
Q

incidence of baby blues

A

50-75% new mums

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13
Q

presentation baby blues

A
  1. tearful
  2. irritable
  3. distress
  4. sometimes brief high
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14
Q

course of baby blues?

A

transient - strts 2nd day ish and lasts max 72hrs

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15
Q

tx for baby blues

A

supportive

if prolonged = risk PND

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16
Q

RFs for baby blues?

A

hx of bad PMS or mood changes on anovulant OCP

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17
Q

PND incidence?

A

10-15% all mothers

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18
Q

PND what is it?

A

not one disorder - combo:

depression
anxiety
adjustment
PTSD

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19
Q

course of PND?

A

90%

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20
Q

recurrence rate PND?

A

20%

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21
Q

symptoms of PND

A

as for depression

20% mum has trouble relating to the baby after delivery

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22
Q

RFs for PND?

A
  1. previous depression
  2. difficult labour
  3. fhx
  4. difficult pregnancy
  5. previous conflict arounf pregnanyc, MC, termination, SB
  6. lack of support
  7. lack of self esteem
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23
Q

mx of PND

A
  1. early detection
  2. prevent with education + support
  3. brief CBT
  4. meds
  5. risk assessment
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24
Q

how is PND measured?

A

Edinburgh PND scale

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25
Q

incidence of PPP?

A

0.1-0.2% (1/500)

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26
Q

onset of PPP?

A

2 weeks after delivery

27
Q

type of PPP?

A
  1. affective (80%) or non affective
  2. 15% schizophreniform
  3. 5% organic
28
Q

cause of PPP?

A

unknown

29
Q

RFs for PPP?

A 
previous hx affective psychosis
fhx affective disorders
previous hx of PPP
previous SB, MC, termination
major life event in pregnancy
lack social support
30
Q

risk of recurrence PPP?

A

60% +

31
Q

tx of PPP?

A
  1. risk assessment - infanticide or suicide
  2. meds: antipsychotics, antidepressants, mood stabilisers
  3. ECT in depressive psychosis
  4. admit to mum and baby unit
  5. need psych support and social support
32
Q

when is max teratogenicity in pregnancy?

A

17-60 days

33
Q

what is the normal spontaneous major malformation rate?

A

2-3%

34
Q

meds + major malformations?

A

only account for 5%

35
Q

1st trimester drugs _____

A

major malformation

36
Q

3rd trimester drugs _______

A

neonatal toxicity

37
Q

In T3 dosing may need to be ______

A

increased due to rise in blood volume

38
Q

mum on drugs, monitor neonate for ________

A

withdrawal

39
Q

recommendations for depression tx in pregnancy?

A

high risk relapse:
1. maintain on AD tx

developed depression during pregnancy:
1. psych first then meds

40
Q

what meds okay for depression in preg?

A

amitryptline
imipramine
fluoxetine

41
Q

what antidepressant to not use in pregnancy?

A

paroxetine
venlafaxine
high risk discontinuation sx in neonate

42
Q

prescribing for psychosis in pregnancy rules?

A
  1. plan pregnancy
  2. if high relapse rate then keep on antipsych during and post
  3. try keep dose low as poss
  4. maintain on whatever they are currently on unless issue with it
43
Q

what antipsych okay in pregnancy?

A

chlorpromazine
haloperidol
olanzepine
clozapine

if poss switch atypical to typical - more data

44
Q

discontinuation sx in neonate?

A

crying
agitation
increased suckling

45
Q

folate and atypicals

A

low folate levels

46
Q

prolactin and fertility?

A

decreases it!

47
Q

antipsychotics are teratogenic?

A

no evidence

48
Q

BPAD mx in pregnancy?

A
  1. can withdraw meds if long time no relapse
  2. don’t stop suddenly- high risk relapse
  3. keep on meds if high relapse
  4. no mood stabiliser safe
49
Q

lithium - must screen for ______ at ______ weeks

A

ebsteins anomaly

6 and 18

50
Q

if on anticonvulsant meds need to give _______

A

more folate

vit K after delivery

51
Q

_______ is associated with cleft palate

A

lamotrigine

52
Q

_________ is the most teratogenic mood stabiliser

A

valproate

53
Q

effects on foetus of anticonvulsants?

A
  1. growth retarded
  2. developmental delay
  3. NTDs
  4. specific syndromes
54
Q

risk of ebsteins anomaly on lithium

A

1/1000

55
Q

risk of relapse in BPAD maintained on lithium?

A

50%

56
Q

benzos in pregnancy?

A
  1. avoid in T1

2. avoid hihgh dose late in pregnancy - hypotonia, hypothermia, resp depression, withdrawal

57
Q

diazepam can cause a ______

A

cleft lip

58
Q

which psychotropic drugs are licensed in pregnancy?

A

none

59
Q

psychotropics in breastfeeding?

A
  1. monitor infants for effects/ feeding patterns/growth
  2. don’t stop tx
  3. use lowest effective dose
  4. no polypharm
  5. time feeds to avoiod peak drug levels or express and give later
60
Q

antiD in breastfeeding?

A

paroxetine or sertraline

61
Q

antipsychotics in breast feeding?

A

olanzepine

sulpiride

62
Q

mood stabilisers in BF?

A

avoid if poss

valproate if must

63
Q

sedatives in BF?

A

lorazepam for anxiety

zolpidem for sleep

64
Q

types of meds good in BF generally?

A

has worked before
was on in pregnancy
short half life

Psych (23 decks)

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